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There is a reduction of RMS in the acute phase of stroke, and RMS was lower in individuals with increased age and BMI.

Objective Rehabilitation top‐down techniques based on brain stimulation present variable outcomes in unilateral spatial neglect (USN) after stroke. This study aimed to examine the effects of physical therapy after anodal and cathodal transcranial direct current stimulation (A‐tDCS and C‐tDCS, respectively) to improve visuospatial and functional impairments in individuals with USN after stroke. Methods This double‐blinded, pilot randomized clinical trial enrolled patients with USN after ischemic stroke. Randomization was stratified according to the Behavior Inattention Test–Conventional (BIT‐C) and Catherine Bergego Scale (CBS). Outpatient physical therapy was conducted for 7.5 weeks after 20 minutes of tDCS. The primary outcome was the USN degree evaluated by the BIT‐C. Secondary outcomes were the difference in CBS score, stroke severity (National Institutes of Health Stroke Scale [NIHSS]), disability (modified Rankin Scale), autonomy (Barthel Index, Functional Independence Measure), and quality of life (EuroQol Group 5‐Dimension Self‐Report Questionnaire). Outcomes were analyzed using an analysis of covariance model corrected by age, baseline NIHSS, and baseline BIT‐C. Pairwise post hoc comparisons were performed using Bonferroni correction. Results In the primary outcomes, A‐tDCS led to greater improvement in BIT‐C after intervention (mean difference [MD] = 18.4, 95% confidence interval [CI] = 3.9–32.8, p = 0.008) compared to sham. However, no significant differences were observed between A‐tDCS and C‐tDCS (MD = 13.9, 95% CI = −0.3 to 28.1, p = 0.057), or C‐tDCS and sham (MD = 4.5, 95% CI = −9.7 to 18.8, p = 0.99). There were no significant differences between groups in terms of secondary outcomes. Interpretation A‐tDCS associated with physical therapy can decrease the severity of USN after stroke. However, these preliminary findings must be confirmed by collecting additional evidence in a larger phase 3 trial. ANN NEUROL 2022;92:400–410

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Introduction. Stroke can lead to musculoskeletal and respiratory dysfunction, chronic deconditioning, and functional limitations, as well as long-term complications. Objective. The aim of this study was to evaluate the association between respiratory function and grip strength in the acute phase of stroke and stroke severity, disability, and autonomy in the long term. Methods. This was a cohort study including 46 patients in the stroke unit. The stroke patients were assessed in the stroke unit at the following moments: at admission by the clinical and haemodynamic stability, demographic and anthropometric data, hand grip strength, stroke severity by National Institutes of Health Stroke Scale (NIHSS) score, and respiratory function using a manovacuometer; during hospitalization by clinical complications and the length of stay; and at hospital discharge and 90 days after discharge by the degrees of functional capacity and dependence using NIHSS, modified Rankin scale (mRs), and Barthel index. Data analysis was performed by multiple linear regression to verify the association between respiratory function and grip strength and the outcomes. Results. The median length of stay in the stroke unit was 7 days. A negative correlation was found between the palmar prehension strength on the unaffected side and mRs at discharge (β=‐0.034, p=0.049). The NIHSS scores at discharge (β=‐0.016, p=0.011) were negatively correlated with the MEP. The Barthel index at discharge was positively correlated with the palmar prehension strength on the unaffected side (β=0.480, p=0.023). Conclusion. It was concluded that a loss of grip strength is associated with a loss of ability and autonomy at discharge and poor respiratory function is associated with stroke severity at discharge.

There is a high demand for stroke rehabilitation in the Brazilian public health system, but most studies that have addressed rehabilitation for unilateral spatial neglect (USN) after stroke have been performed in high-income countries. Therefore, the aim of this study was to analyze USN patient recruitment in a multicenter noninvasive brain stimulation clinical trial performed in Brazil and to provide study design recommendations for future studies. We evaluated the reasons for exclusion of patients from a multicenter, randomized, double-blinded clinical trial of rehabilitation of USN patients after stroke. Clinical and demographic variables were compared between the included and excluded patients. A descriptive statistical analysis was performed. Only 173 of the 1953 potential neglect patients (8.8%) passed the initial screening. After screening evaluation, 87/173 patients (50.3%) were excluded for clinical reasons. Cognitive impairment led to the exclusion of 21/87 patients (24.1%). Low socioeconomic status led to the exclusion of 37/173 patients (21.4%). Difficulty obtaining transportation to access treatment was the most common reason for their exclusion (16/37 patients, 43.3%). The analyzed Brazilian institutions have potential for conducting studies of USN. The recruitment of stroke survivors with USN was restricted by the study design and limited financial support. A history of cognitive impairment, intracranial stenting or craniectomy, and lack of transportation were the most common barriers to participating in a multicenter noninvasive brain stimulation trial among patients with USN after stroke.

Background: Respiratory muscle function can be compromised during the acute phase and this study aims to assess the effectiveness, feasibility, and safety of short-term expiratory muscle training in acute stroke patients. Additionally, we will assess the effects of expiratory muscular training on the electromyographic activity of the abdominal muscle, vital capacity, stroke severity, hand grip strength, functional independence, autonomy, and quality of life. Methods: This single-center, randomized, single-blind, parallel-group study of 88 patients with stroke will include the following groups: 1) an intervention group that will undergo expiratory muscle training, physical therapy, and standard care (n = 44) and 2) a control group that will only undergo physical therapy and standard care (n = 44). The primary outcome is respiratory muscle strength assessed via inspiratory and expiratory pressures (cmH2O). The secondary outcomes are electromyography activity of the rectus abdominis muscle and abdominal external oblique muscle, vital capacity measured by a ventilometer, handgrip strength, stroke severity and disability [National Institutes of Health Stroke Scale, modified Rankin Scale, and Barthel index], and quality of life. We will assess all variables before and after the intervention. The delta will be compared between the groups (intervention vs. control) using Student t-test for normal distribution and Mann-Whitney test for skewed distribution. The data will be analyzed using SPSS and results with P-values <.05 will be considered statistically significant. Discussion: The ACANTHUS trial has clinical relevance and is necessary since previous studies have revealed that respiratory rehabilitation after stroke improves patients’ functional capacities. Trial Registration: Registro Brasileiro de Ensaios Clínicos (Rebec) - RBR-8w44f6